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Heart failure (HF) is a major health problem in both the developed and the developing countries. In the United States, it is estimated that more than 5 million people are living with heart failure and more than 470,000 new cases annually. Research indicates that the incidence of HF increases with age and the prevalence is not related to gender. HF is associated with increased rates of morbidity and mortality. The condition results from the inability of the heart to pump blood thus the reduced productivity and increased burden in the society. This paper aims at discussion HF in depth.
Risk factors and Causes
Advancing age and Coronary Heart Disease are the primary risk factors for the development of HF. Other factors that have been associated with the condition include obesity, hypertension, cigarette smoking, diabetes; high serum cholesterol levels (American Heart Association, 2015). The most common causes of HF include heart attack, high blood pressure, cardiomyopathy, heart valves problems or congenital heart problems. HF can occur suddenly (acute) or slowly (chronic) over several months.
The clinical manifestations of patients with chronic heart failure include fatigue, dyspnea, tachycardia, edema, skin changes chest pain and weight changes. Fatigue is usually the earliest symptom of HF. It mainly results from the decreased cardiac output, reduced tissue perfusion and therefore, the patient is unable to carry out activities that usually are not tiring. Difficulty in breathing (dyspnea) results from increased pulmonary pressures and can be mild on exertion or at rest. in tachycardia, due to the decreased cardiac output, there is the increased stimulation of the sympathetic nervous system leading to increased heart rate. Edema is a universal sign of HF occurring in the lower limbs, the sacral region, abdominal peritoneal cavity and also pulmonary edema.
Fig a. A comparison between a normal heart and one a diseased (heart failure).
Clinical Findings and Diagnostic Findings
The diagnosis of HF is difficult since neither signs nor the symptoms are specific and they often mimic other disorders. The initial diagnosis aims at determining the underlying cause of the disease which includes history taking, physical examination chest x-ray, electrocardiogram (ECG), laboratory findings (cardiac enzymes, Liver function tests, complete blood count), hemodynamic studies, echocardiogram and cardiac catheterizations.
Cardinal finds of Heart Failure include cardiomegaly, dyspnea, and edema; however, cardiac heart failure can occur in the presence or the absence of those signs. There are no specific signs and symptoms of HF and the diagnosis often depend on the constellation of the patient's findings and symptoms. As such, with heart failure, other organs are investigated for confirmatory or collaborative evidence so as to make the diagnosis of HF. some of the differential diagnosis for HF include anemia and lung disease. Other diseases include acute kidney injury, nephrotic injury, conditions of the lungs such as respiratory failure, pulmonary embolism, pneumonia, emphysema and chronic obstructive pulmonary disease (Kasper, 2015).
Objective of medical management is correct the sodium-water imbalance and volume overload, reduction of the cardiac workload, improvement of the cardiac contractility and controlling the precipitating and complicating factors. The management aims at improving the symptoms, minimizing the side effects, reducing the morbidity and improving the quality of life (Kasper, 2015). Significant agents used include the diuretics, vasodilators, beta blockers and the inotropic agents. Diuretics help in reducing the pulmonary pressure and lessen the preload. As such, these agents act on the kidney hence promoting the excretion of the sodium and water.
Drugs used in this category include furosemide, spironolactone, and hydrochlorothiazides (Kasper,2015). The vasodilators increase the venous capacity thereby improving the ventricular contractility. The angiotensin-converting enzyme inhibitors are used in the first line of therapy. Agents used as ACE include enalapril and captopril. Positive inotrope agent’s aim at improving the cardiac contractility to increase the cardiac output, decrease the ventricular diastole pressure, agents used in this category include the digitalis such as the digoxin, dobutamine, beta-adrenergic agonists and calcium sensitizers.
Prognosis of Cardiac Failure
Heart failure is a progressive disease associated with periods of exacerbations. Various factors determine the outlook for a particular patient including the underlying cause, degree of the heart impairment and the response to medication (American Heart Association, 2015). Over the past decade, there has been an improvement in the treatment of HF due to the availability of newer drugs as well as better specific treatment options. The prognosis of heart failure is dependent on the extent the heart has been damaged. In cases where there is a mild destruction of the heart and no availability of other factors, there is better prognosis; however, with 50% impairment of the heart resulting in impairment of the heart function, there is often inadequate prognosis increasing the cases of mortality (Kasper, 2015).
Ethical Implications of Heart Failure Management
Health care professionals managing cardiac patients have a responsibility in ensuring their patients fully understand the benefits and the disadvantages of the available treatment options. There has been the advancement in technology including specialized therapies such as heart transplantation, ventricular assist devices, and cardiac resynchronization therapy. The new interventions have created the array of treatment which is beyond medications for the clinicians to use in the treatment for the treatment of patients with heart failure. Majority of the patients have recovered from heart failure, and their quality of life has improved due to stenting of the intravenous thrombotic medications, the presence of coronary artery bypass as well as angioplasty (Braunwald, 2015). However, the availability of the treatment interventions has been associated with significant tradeoffs. In most cases, some patients experience the essential quality of life issues such as pain, depression, stress as well as a substantial economic burden. Health care providers often offer very little attention in ensuring that patients who have heart failure understand the treatment options including the impact of the treatment options which is inconsistent with the principle of patient-centered care.
Over the years, there has been an increase in the number of cardiology sponsored researchers which have raised so many issues regarding the protection of the patients; other ethical issues include informed consent, conflict of interest in the research field (Braunwald, 2015). Various measures have been laid out by the different research institutes across the world to ensure the improvement of the protocols to improve informed consent, data safety as well as disclosure of the financial conflicts of interest. Despite all the measures, there have been several issues in heart failure which have not mainly been addressed (Braunwald, 2015). The applicability of a new drug or a cardiac device to the general population of the patients with heart failure often raises issues on the success and the failure. The treatment options have not lead to a reduction in the economic burden as well as an improvement in the productivity of the individuals with HF. Therefore, there is the need for newly approved therapies which will improve the quality of life as well as have a lesser financial burden to the society (Braunwald, 2015).
Heart Failure is progress heart disease leading to a decline in the function of the heart as well as a significant burden to the associated patient. Hypertension, coronary heart disease, and faulty valves are some of the significant causes of heart failure. However other factors such as obesity, alcohol intake and smoking have greatly been attributed to the development of heart failure. Patients with Heart Failure presents with dyspnea, edema, fatigue, and tachycardia. The diagnosis includes the evaluation of both the laboratory and radiological studies. Treatment aims at improving the quality of life and lessening the symptoms and provides for the administration of the diuretics, vasodilators, and inotropes. The prognosis is dependent on the treatment availability and the extent of the destruction of the heart muscles. Despite the advancement in technology which has led to the improvement in the quality of life, however, several issues have evolved. This includes the effectiveness of the new therapies and the associated impact on the quality of life as well as informed decision making. There is, therefore, the need for better interventions considering all the aspects of the patients.
American Heart Association. "Classes of heart failure." Avaiable from: http://www. abouthf. org/questions_stages. htm(2015).
Braunwald, Eugene. "The war against heart failure: the Lancet lecture." The Lancet 385.9970 (2015): 812-824.
Kasper, Dennis, et al. "Harrison's principles of internal medicine, 19e." (2015).
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